Hypertriglyceridemia - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:09:09Z

Prepared the page for translation

Kxl328: /* Management */

2021-06-02T13:56:28Z

Management

← Revisión anterior		Revisión del 13:56 2 jun 2021
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	*Evidence for management based on case series and reports<ref>Santana YR et al. Treatment of severe hypertriglyceridemia with continuous insulin infusion. Case Reports in Critical Care. June 2011.</ref><ref>Poonuru S et al. Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin. Clin Med Res. 2011 Mar; 9(1): 38–41.</ref>		*Evidence for management based on case series and reports<ref>Santana YR et al. Treatment of severe hypertriglyceridemia with continuous insulin infusion. Case Reports in Critical Care. June 2011.</ref><ref>Poonuru S et al. Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin. Clin Med Res. 2011 Mar; 9(1): 38–41.</ref>
	*[[Insulin]] drip - most dramatic and rapid intervention, with reduction within 24 hrs		*[[Insulin]] drip - most dramatic and rapid intervention, with reduction within 24 hrs
	**Initiate at 0.1 units/kg/hr (similar to treatment for DKA		**Initiate at 0.1 units/kg/hr (similar to treatment for DKA)
	**Goal is to reduce triglycerides to < 500		**Goal is to reduce triglycerides to < 500
	**Add D5NS if glucose drops < 200 <ref>Schaefer EW. Management of Severe Hypertriglyceridemia in the Hospital: A Review. Journal of Hospital Medicine Vol 7\|No 5\|May/June 2012.</ref>		**Add D5NS if glucose drops < 200 <ref>Schaefer EW. Management of Severe Hypertriglyceridemia in the Hospital: A Review. Journal of Hospital Medicine Vol 7\|No 5\|May/June 2012.</ref>

Rossdonaldson1 at 16:50, 12 December 2019

2019-12-12T16:50:35Z

← Revisión anterior		Revisión del 16:50 12 dic 2019
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	===Hypertriglyceridemic Pancreatitis===		===Hypertriglyceridemic Pancreatitis===
	''Signs/symptoms of pancreatitis''		''Signs/symptoms of pancreatitis''
	*[[Epigastric pain\|Pain]] is the most common symptom and is often characterized by:~~<ref name="NEJM"></ref>~~		*[[Epigastric pain\|Pain]] is the most common symptom and is often characterized by:
	**Persistent		**Persistent
	**Localizes to epigastric area, around waist, RUQ, or occasionally LUQ		**Localizes to epigastric area, around waist, RUQ, or occasionally LUQ

Rossdonaldson1 at 16:50, 12 December 2019

2019-12-12T16:50:06Z

← Revisión anterior		Revisión del 16:50 12 dic 2019
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	*TG levels > 2000mg/dL almost always have both secondary and genetic form<ref>Yuan et al. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007;176:1113-1120.</ref>		*TG levels > 2000mg/dL almost always have both secondary and genetic form<ref>Yuan et al. Hypertriglyceridemia: its etiology, effects and treatment. CMAJ 2007;176:1113-1120.</ref>
	*1.7% of US estimated to have [TG] between 500-2000<ref>Brown, Virgil W. Et al. “Clinical Lipidology Roundtable Discussion: Severe Hypertriglyceridemia.” Journal of Clinical Lipidology 2012; 6:397-408</ref>		*1.7% of US estimated to have [TG] between 500-2000<ref>Brown, Virgil W. Et al. “Clinical Lipidology Roundtable Discussion: Severe Hypertriglyceridemia.” Journal of Clinical Lipidology 2012; 6:397-408</ref>
	~~[[File:hypertriglyceridemia_green_top.jpg\|thumbnail]]~~
	*May present with normal serum lipase levels		*May present with normal serum lipase levels

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	==Evaluation==		==Evaluation==
			[[File:hypertriglyceridemia_green_top.jpg\|thumbnail]]
	*Triglycerides; Severely elevated (at least >500 mg/dL, generally >1,000 mg/dL)		*Triglycerides; Severely elevated (at least >500 mg/dL, generally >1,000 mg/dL)
	**Lipids in serum may interfere with other lab tests		**Lipids in serum may interfere with other lab tests

Rossdonaldson1: /* Clinical Features */

2019-12-12T16:49:42Z

Clinical Features

← Revisión anterior		Revisión del 16:49 12 dic 2019
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	==Clinical Features==		==Clinical Features==
	===General===		===General===
			[[File:Xanthoma.jpg\|thumb\|A pediatric patient's knee showing multiple xanthoma tuberosum (i.e. xanthoma located over a joint).]]
	*Most are generally asymptomatic until sequelae present		*Most are generally asymptomatic until sequelae present
	*Eruptive xanthoma may be found on dermatologic exam		*Eruptive xanthoma may be found on dermatologic exam

Rossdonaldson1: /* Clinical Features */

2019-12-12T16:36:08Z

Clinical Features

← Revisión anterior		Revisión del 16:36 12 dic 2019
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	==Clinical Features==		==Clinical Features==
			===General===
			*Most are generally asymptomatic until sequelae present
			*Eruptive xanthoma may be found on dermatologic exam

	===Hypertriglyceridemic Pancreatitis===		===Hypertriglyceridemic Pancreatitis===
	''Signs/symptoms of pancreatitis''		''Signs/symptoms of pancreatitis''

Shihabali at 06:08, 22 November 2019

2019-11-22T06:08:46Z

← Revisión anterior		Revisión del 06:08 22 nov 2019
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	*Evidence for management based on case series and reports<ref>Santana YR et al. Treatment of severe hypertriglyceridemia with continuous insulin infusion. Case Reports in Critical Care. June 2011.</ref><ref>Poonuru S et al. Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin. Clin Med Res. 2011 Mar; 9(1): 38–41.</ref>		*Evidence for management based on case series and reports<ref>Santana YR et al. Treatment of severe hypertriglyceridemia with continuous insulin infusion. Case Reports in Critical Care. June 2011.</ref><ref>Poonuru S et al. Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin. Clin Med Res. 2011 Mar; 9(1): 38–41.</ref>
	*[[Insulin]] drip - most dramatic and rapid intervention, with reduction within 24 hrs		*[[Insulin]] drip - most dramatic and rapid intervention, with reduction within 24 hrs
	**~~5-10~~ units/hr ~~with or without dextrose infusion~~ to ~~maintain BSs ~150mg/dL~~		**Initiate at 0.1 units/kg/hr (similar to treatment for DKA
	**~~May require higher dosages for diabetics, 0.1–0.3 U/kg/hr~~		**Goal is to reduce triglycerides to < 500
	**~~Titrate to BS 140–180mg/dL~~<ref>Schaefer EW. Management of Severe Hypertriglyceridemia in the Hospital: A Review. Journal of Hospital Medicine Vol 7\|No 5\|May/June 2012.</ref>		**Add D5NS if glucose drops < 200 <ref>Schaefer EW. Management of Severe Hypertriglyceridemia in the Hospital: A Review. Journal of Hospital Medicine Vol 7\|No 5\|May/June 2012.</ref>
			**Monitor BMP q2 hr
			**Manage potassium
			***K < 3.2 stop insulin and replete K
			***K 3.3 to 5 add 20 mEq K/Lto IVF
			***K > 5 no extra potassium
			*IVF as for standard pancreatitis treatment, add potassium as per above
	*Treat concurrent [[hypothyroidism]] if present		*Treat concurrent [[hypothyroidism]] if present
	*Pain control		*Pain control
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	**No fat diet		**No fat diet
	**Low calorie diet		**Low calorie diet
	*Follow TG levels, goal < 500-1000mg/dL by discharge

	====[[Plasma exchange]]====		====[[Plasma exchange]]====
	*Therapeutic plasma exchange, for 1-3 days (sickest patients)		*Therapeutic plasma exchange, for 1-3 days (sickest patients)
			**Generally indicated for hypocalcemia, persistent elevated lactic acidosis, other signs of worsening organ dysfunction
	*For euglycemic patients, not routine first line		*For euglycemic patients, not routine first line
	*Requires central venous access		*Requires central venous access

ClaireLewis at 17:55, 22 September 2019

2019-09-22T17:55:23Z

@@ Línea 19: / Línea 19: @@
 ==Clinical Features==
+===Hypertriglyceridemic Pancreatitis===
 ==Differential Diagnosis==
 ==Evaluation==

Rossdonaldson1: /* Management */

2019-05-17T01:49:02Z

Management

← Revisión anterior		Revisión del 01:49 17 may 2019
Línea 47:		Línea 47:
	*Follow TG levels, goal < 500-1000mg/dL by discharge		*Follow TG levels, goal < 500-1000mg/dL by discharge

	===[[Plasma exchange]]===		====[[Plasma exchange]]====
	*Therapeutic plasma exchange, for 1-3 days (sickest patients)		*Therapeutic plasma exchange, for 1-3 days (sickest patients)
	*For euglycemic patients, not routine first line		*For euglycemic patients, not routine first line

Rossdonaldson1 at 01:48, 17 May 2019

2019-05-17T01:48:37Z

@@ Línea 18: / Línea 18: @@
 *An acidic environment potentiates free fatty acid toxicity
-==Management of Pancreatitis==
+==Clinical Features==
 *Evidence for management based on case series and reports<ref>Santana YR et al. Treatment of severe hypertriglyceridemia with continuous insulin infusion. Case Reports in Critical Care. June 2011.</ref><ref>Poonuru S et al. Rapid Reduction of Severely Elevated Serum Triglycerides with Insulin Infusion, Gemfibrozil and Niacin. Clin Med Res. 2011 Mar; 9(1): 38–41.</ref>
 *[[Insulin]] drip - most dramatic and rapid intervention, with reduction within 24 hrs
@@ Línea 42: / Línea 53: @@
 ==Disposition==
-*ICU or step-down for frequent labs, insulin drip
+*Asymptomatic hypertriglyceridemia is treated as an outpatient
 ==References==